Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
: '" COMMUNITY DEVELOPMENT Permit#: ELR2016 00149
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/15/2016
Parcel: 2S 101 AA02900
Jurisdiction: Tigard
Site address: 12123 SW 69TH AVE
Project: Spec Space-Builidng A Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project Description: Modification to HVAC low voltage panel.
Contractor: HEINZ MECHANICAL SERVICE INC Owner: SDC TIGARD CORPORATE CENTER INC
2615 NW ST HELENS RD ATTN:ANDREW HARPER
PORTLAND, OR 97210 101 CALIFORNIA ST, 26TH FLOOR
SAN FRANCISCO, CA 94111
PHONE: 503-220-0855 PHONE:
FAX: 503-220-0260
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/15/2016 $75.00
12%State Surcharge-Electrical 06/15/2016 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 1 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTEN : Ore., law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 through OAR 9' -0' -0/c. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/ . 1% r S
Issue By: - Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
II
City of Tigard JLFCE!VE[' Date. :Received (Q® Permit#: � ) ��/�-O0 iV,
- 13125 SW Hall Blvd.,Tigard,OR Plan Review
C�—
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175y n Ready Date/By: loris: ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov JUN 1 5 2 11 5 Notified/Method: Supplemental Information
TYPE OF3Vr(IiItK,rai; Hi__4. �t PLAN REVIEW
❑New construction �Additi0 t acelil n Please check all that apply(submit 2 sets of plans w/items checked):
L01 I f D I e,,'Ip ) : 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition El Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: �. Swl ( C11 Addition of new motor load of system.
AveAvE 100HPormore. ❑"A" "E" "]-2" "1-3„
City/State/ZIP: (;Z►a3 El Six or more residential units. occupancy.
�.1 tAr 012... ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: V Project name: ❑Hazardous locations. 0 Supply voltage for more than
O J S UWtw C (l)(al- ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total L.
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: - - --
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
1 (with above sq.ft.) 75.00 2
i'hoddr-lCt-h�1 6, Lo-..t 1/01.1 t We— 5'..�7er't1 Limited energy,gy,multi-family 75.00 2
.5f7eC�fq�t`J Jl- J�J t IC�tV I "?., .,.,. .r j-::.-' residential(with above sq.ft.) .
• Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: de,r4 (t4 , ( sett Vice_ above service or feeder fee,
7.42 2
each branch circuit
Contact name: (-).a, /. I`_ e-6(2) B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 046 S6 Li f.1/ Ali_ branch circuit
City/State/ZIP: -0045r3 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 50 j) t)S 1 - Q—.9-ac, Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: w z- ryec-6 ,J;c ,e444,t Sign or outline lighting 67.84 2
Da
Address: .2L NW S.' /--I �i �„_--Q Signalneaclteration,
n or limited-energyxes . M See Page 2 75• 2
D�� L /„"�..,� panel,alteration,or extension. f�
City/State/ZIP: h Gr Each additional inspection over allowable in anyof the above
(J_a.s (.a..lt� C_�- Z f P
Additional inspection(1 hr min) 66.25/hr
Phone:(S:)3 ) ,Q A02Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Cab _19 LJ t„2 SC,2''C . Co oil(l1 Industrialspectoplant(1 ishr no) 78.18/hr
v) Inspections for which no fee is 90.00/hr
CCB Lic.: 1(>152,(1, Electrical Lic.: 4mi/66 Suprv.Lic.: specifically listed('/hr min)
/ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: C2 t 92-- '?!/ll7 Subtotal: 75-.0.9
Print name: L7/IBILL c Date: 6 -f 0 Plan Review Required(25%of permit fee): ____.---
State surcharge(12%of permit fee): 7.00
TOTAL PERMIT FEE: ¢
Authorized signature: c/,6e
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(II/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description Qty. I Each I Total
Fee for all residential systems combined: $75.00 I
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
COMMERCIAL WORK ONLY: _ ELECTRICAL PERMIT FEES
Fee for each commercial system:. $75.00
' Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12123 SW 69TH AVE, TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00149
Chip Barnett
Violation Summary:
Inspector Contractor